Provider Demographics
NPI:1073909966
Name:STOKES, RYAN JIMEL (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:JIMEL
Last Name:STOKES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2501
Mailing Address - Country:US
Mailing Address - Phone:816-753-5144
Mailing Address - Fax:855-737-0585
Practice Address - Street 1:2340 E MEYER BLVD BLDG 1
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-1105
Practice Address - Country:US
Practice Address - Phone:816-753-5144
Practice Address - Fax:855-737-0585
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-08
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018009504207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2018009504OtherLICENSE